Comparative Efficacy of Quadruple Vs Triple Anti Helicobacter Treatment in The Management of Duodenal Ulcer Disease in Pakistani Population.

Abstract

Gastric Helicobacter isolates from the sub- continent people have been found to have high prevalence of in vitro resistance for nitroimidazoles and an effective anti-helicobacter regimen remains a problem in our set up. Initial ulcer healing has never been a problem rather it is the relapse of the ulcer which is a clinical challenge, and if Hp eradication can be achieved, ulcer relapse should not remain a problem. An ideal Hp eradication regimen should be short, effective, and well tolerated and in order to find one, a randomized study was designed to compare triple Vs quadruple anti Hp regimen. Endoscopically proven uncomplicated rapid urease positive duodenal ulcer patients were divided into two groups of fifty patients each. Group I was given Lanzoprazole 30mg bid along with amoxycillin 1gm bid and clarithromycin 250mg bid for seven days. Group II was given all the above medicines plus Tinidazole 500mg bid for seven days. Endoscopy was repeated after three months to evaluate Hp status by doing urease test and histopathology. 46 patients in group I (92%), and 40 patients in group II (80%) completed the seven days course of treatment. Two patients in each group didn’t turn up for follow up (4%). At the end of three months, H. pylori was detectable on histopathology in 11(11/46) patients and rapid urease test was positive in 13 (13/4) patients of group I while corresponding figures were of one patient only (1/40) in group II. Interestingly all the patients were reported to have mild chronic active superficial gastritis on histopathology at the end of three months. Thus we conclude that quadruple anti Hp treatment is though less tolerated but is more effective in the eradication of H. pylori as compared to the triple therapy.